Health Plan Weekly

Since open enrollment began on Nov. 1, nearly 7.3 million people have signed up for Affordable Care Act health exchange plans for 2024, according to CMS. The data is through Dec. 2 for the 32 states that use the HealthCare.gov website and through Nov. 25 for the 18 states and Washington, D.C., that have state-based exchanges. More than 1.6 million of the people who enrolled, or about 23% of the total, did not have marketplace coverage in 2023. Enrollment runs through Jan. 15, 2024, for the states using HealthCare.gov, while the deadlines vary for state-based exchanges.  

Optum, UnitedHealth Group’s health services arm, employs or has contracts with nearly 90,000 physicians and an additional 40,000 advanced practice clinicians, according to Optum Health CEO Amar A. Desai, M.D. Since there are about 950,000 active physicians in the country, that means Optum employs just under 10% of them. Desai, who spoke at UnitedHealth’s investor meeting on Nov. 29, added that Optum serves not only UnitedHealth’s members but also beneficiaries from more than 100 health plans. In addition, Optum serves more than 4 million people in fully accountable care arrangements and expects that number to increase to 5 million by late 2024.  

The Cigna Group is reportedly discussing a multibillion-dollar deal with Humana Inc. that would create a diversified health insurance giant capable of going toe-to-toe with UnitedHealth Group and CVS Health Corp.  

Industry observers agree that such a transaction would receive robust regulatory scrutiny — with many predicting a high likelihood that federal officials will lob a legal challenge. However, opinions vary about how much the companies’ respective PBM businesses present a major antitrust risk. 

News of the potential deal came from a Nov. 29 Wall Street Journal article, which cited people familiar with the matter speaking on condition of anonymity. Assuming the talks don’t fall apart, the terms of the deal could be finalized by the end of the year, the article stated.  

Hype of artificial intelligence reached new heights in 2023, and the health care industry was no exception to that trend. Health insurance firms have been among the first organizations to deploy previous generations of big data tools at scale, and in turn, AI is set to proliferate among health insurers in the near future. How AI adoption will actually impact health insurance operations and finances is an open question.  

Some insiders, like Moody’s Investors Service analysts, expect health insurers to reap dramatic operational and financial benefits by deploying AI. Other experts disagree, including a group of Stanford University researchers who published a Nov. 16 op-ed in JAMA arguing that due to the extreme complexity of medical administration in the U.S., AI using large language models (LLMs) “might exacerbate billing challenges for physicians” and could lead to additional challenges of filed claims by carriers. 

During UnitedHealth Group’s annual Investor Day, analysts focused largely on looming challenges for the firm’s Medicare Advantage business. Yet the company’s executives also revealed some intriguing details about new benefit designs gaining traction in the company’s commercial insurance book of business. 

In reviewing the updated 2024 financial estimates that UnitedHealth released before its Nov. 29 Investor Day, Wells Fargo analyst Stephen Baxter advised investors that “we see higher-than-expected MLR [medical loss ratio] and more modest MA membership growth as items to pick at.”